Systems and methods for a health care e-commerce marketplace

ABSTRACT

Systems and methods for an e-commerce health care marketplace are provided. In one embodiment, a method comprises, responsive to a query from a user, retrieving from a database a list of responses comprising one or more health care providers offering one or more health care services at a provider-supplied price; filtering the list of responses based on a geographic location included in the query; providing, for display, the filtered list of responses; receiving a payment from the user for a response selected from the filtered list of responses; automatically sending a notification of the payment to a provider associated with the selected response; and responsive to receiving an order fulfillment notification from the provider, automatically providing the payment to the provider. In this way, health care consumers may make informed purchasing decisions when shopping for health care services and health care providers may receive prompt payment for services delivered.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a divisional of U.S. patent application Ser.No. 16/890,956, entitled “SYSTEMS AND METHODS FOR A HEALTH CAREE-COMMERCE MARKETPLACE”, filed Jun. 2, 2020, which is a divisional ofU.S. patent application Ser. No. 14/845,170, entitled “SYSTEMS ANDMETHODS FOR A HEALTH CARE E-COMMERCE MARKETPLACE”, filed Sep. 3, 2015,which claims priority to U.S. Provisional Patent Application No.62/048,157, entitled “SYSTEMS AND METHODS FOR AN ONLINE HEALTH CAREMARKETPLACE,” filed on Sep. 9, 2014. The entire contents of each of theabove-mentioned applications are hereby incorporated by reference forall purposes.

BACKGROUND/SUMMARY

In the modern world, consumers are accustomed to a wide array of optionswhen shopping for goods and services. Furthermore, online shoppingenables consumers to make an informed purchasing decision by comparingproducts by price and quality, for example. However, in today's healthcare marketplace, consumers are unable to shop for health care services,which may include medical treatments, dental services, mental healthservices, prescriptions, alternative health services, and any othermedical services or goods, the way they shop for virtually every othergood and service.

Indeed, health care consumers are often uninformed regarding theexpenses they are incurring when purchasing health care services. Forexample, health care consumers are currently limited to visiting ahealth care provider in order to receive health care services withoutknowing how much the services will cost until the health care consumerreceives an Explanation of Benefits (EOB) statement from his or herhealth insurance company and a bill from the health care provider. SuchEOB statements typically outline the services rendered by using crypticcommon procedure terminology (CPT) codes.

The price of health care services is further obscured by the variabilityof health care plan benefits. For health care consumers, identifyingwhat health care services may be covered by a health care plan isexceedingly difficult, let alone understanding the extent of coverage.Even when a health care consumer eventually receives an EOB statement,he or she may be surprised to find that his or her health insurance doesnot cover a health care service that the health care consumer alreadyreceived and expected to be covered.

Aside from the obfuscation of health care insurance benefits, healthcare services and associated prices are highly variable from provider toprovider. Such variability results from complex contractual agreementsbetween providers and insurance companies. As a result, health careconsumers may expect to pay a particular price for a health care servicebased on previous experience, only to discover that a different providercharges a different price for the same health care service. Given theclosed nature of the current health care marketplace, even health careproviders themselves may not be aware of how much they differ cost-wisefrom other providers.

The deficiencies of the health care marketplace not only negativelyaffects health care consumers, but health care providers as well. Forexample, health care providers provide health care services prior toreceiving payment. Furthermore, health care providers may be delayed inreceiving payment for their services from a health care consumer for anindeterminate amount of time, possibly resulting in a prolonged debtcollection situation that everyone involved would prefer to avoid.

Thus, health care consumers need a standardized way to shop for andcompare health care services. The inventors have recognized the aboveissues and have devised several approaches to address them. Inparticular, systems and methods for a health care e-commerce marketplaceare provided. In one embodiment, a method comprises, responsive to aquery from a user, retrieving from a database a list of responsescomprising one or more health care providers offering one or more healthcare services at a provider-supplied price; filtering the list ofresponses based on a geographic location included in the query;providing, for display, the filtered list of responses; receiving apayment from the user for a response selected from the filtered list ofresponses; automatically sending a notification of the payment to aprovider associated with the selected response; and responsive toreceiving an order fulfillment notification from the provider,automatically providing the payment to the provider. In this way, healthcare consumers may make informed purchasing decisions when shopping forhealth care services and health care providers may receive promptpayment for services delivered.

In another embodiment, a computer-readable storage medium includes anexecutable program stored thereon, the program configured to cause acomputer processor to: retrieve health care claims data from one or moredatabases; process the health care claims data to identify a combinationof current procedural terminology (CPT) codes provided to a plurality ofpatients in a single health care interaction; assemble the combinationof CPT codes into a bundle of health care services; generate a productcode for a bundle of health care services; receive a price for theproduct code from a health care provider; generate a health care servicebundle indicator for the health care provider based on the product code;and assign the price to the health care service bundle indicator. Inthis way, health care services offered by health care providers may benormalized and health care consumers may shop for and purchase healthcare service bundle indicators in a health care e-commerce marketplace.

In another embodiment, an apparatus facilitating a health caremarketplace comprises a processor and memory storingprocessor-executable instructions that cause the processor to: receive,from a user, a payment for a bundle of health care services provided bya health care provider prior to the user visiting the health careprovider; automatically generate receipt documentation responsive toreceiving an order fulfillment notification from a health care providerindicating that the user received the bundle of health care servicesfrom the health care provider, wherein the receipt documentationincludes one or more current procedural terminology (CPT) codesassociated with the bundle of health care services; send, to the user,the receipt documentation formatted for display to the user andincluding a non-technical description of the one or more CPT codes; andsend, to an insurance administrator for a health insurance plan of theuser, the receipt documentation formatted as a health care claim. Inthis way, health care consumers can easily track their health carespending and health care providers no longer need to deal with writingand submitting health care claims to insurance administrators.

The above summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This summary is not intended to identify key features oressential features of the subject matter, nor is it intended to be usedto limit the scope of the subject matter. Furthermore, the subjectmatter is not limited to implementations that solve any or all of thedisadvantages noted above or in any part of this disclosure.

BRIEF DESCRIPTION OF THE FIGURES

FIGS. 1A-1D show high-level illustrations of an example e-commercehealth care platform.

FIGS. 2A-2B illustrate example methods for bundling health care servicesinto a health care service bundle indicator.

FIGS. 3A-3C show high-level flow charts illustrating example methods fora health care provider using an e-commerce health care platform.

FIGS. 4A-4F illustrate example e-commerce health care platforminterfaces for a health care provider.

FIG. 5 shows a high-level flow chart illustrating an example method fora health care consumer using an e-commerce health care platform.

FIGS. 6A-6L illustrate example e-commerce health care platforminterfaces for a health care consumer.

FIG. 7 shows a high-level flow chart illustrating an example method forproviding and billing for health care services according to prior art.

FIG. 8 shows a high-level flow chart illustrating an example method forproviding and billing for health care services with an e-commerce healthcare platform.

FIG. 9 illustrates an example method for personalizing an e-commercehealth care platform for a health care consumer.

DETAILED DESCRIPTION

The present description relates to systems and methods for an e-commercehealth care marketplace. In particular, systems and methods are providedfor selling standardized bundles of health care services. Consumers needa way to shop for and compare health care services in a standardizedway. Today, provider services and pricing are highly variable, andconsumers cannot easily compare services because of variations in CPTcodes when shopping for and selecting these services. The systems shownin FIGS. 1A-1D provide for the formation of a standardized bundle ofcare that can be stocked and sold in an e-commerce marketplace. As shownin FIGS. 2A-2B, the goal of the standardized bundle of care, referred toherein interchangeably as a health care service bundle indicator or aHEALTHSKU™ indicator, is to curate the health care service shoppingexperience in a way that is meaningful and easily understood by theconsumer. This health care service bundle indicator comprises a sequenceof alphanumeric characters which identify a defined set of CPT codes, aprovider and any network affiliations, and a geographic location of theprovider. A health care provider may enroll in and use the e-commercemarketplace platform via several methods, such as those shown in FIGS.3A-3C. As shown by FIGS. 4A-4F, the health care service bundle indicatorwill be stocked by providers on an e-commerce platform, and providerscan set up an account on the e-commerce platform such that payment forthe bundled health care services, which have provider-adjustable prices,is facilitated by the e-commerce platform. As shown by FIGS. 5-6L,health care service bundle indicators may be purchased by consumersthrough the e-commerce platform before visiting a health care provider.The e-commerce platform may take health care plan coverage intoconsideration so that consumers do not need to be reimbursed later.After a health care consumer purchases a health care service bundleindicator, a provider fulfills the order. In addition to simplifying ahealth care consumer's experience of purchasing health care services,the system described herein further simplifies the billing systemoverall, as depicted in FIGS. 7-8 . As consumers and providers utilizethe e-commerce platform, over time the e-commerce platform offerspersonalized health care service bundle indicator recommendations forusers, as depicted in FIG. 9 .

FIG. 1A shows a high-level diagram illustrating an example health caresystem 100 in accordance with the current disclosure. In particular,health care system 100 illustrates how an e-commerce platform 101 mayfacilitate the selling and purchasing of health care services between ahealth care consumer 102 and a health care provider 104, with additionalinteraction between the e-commerce platform 101 and a health care planadministrator 103, a payment processor 105, a financial institution 106,and a clearinghouse 107.

As described further herein with regard to FIG. 1B, each component ofhealth care system 100 depicted in FIG. 1A may represent one or morecomputing devices capable of transmitting information, and theinteractions between components may represent the flow of informationbetween each computing device. As such, health care system 100 may beconsidered a computing environment in accordance with the currentdisclosure. Each computing device, such as the e-commerce platform 101,is shown in simplified form. However, each computing device in healthcare system 100 may take the form of one or more personal computers,server computers, tablet computers, home entertainment computers,network computing devices, mobile computing devices, mobilecommunication devices, and/or other computing devices. Each computingdevice in health care system 100 may include one or more displays fordisplaying an interface. For example, a provider device may include adisplay for displaying interfaces such as the interfaces describedfurther herein and with regard to FIGS. 4A-4F, while a health careconsumer computing device may include a display for displayinginterfaces such as the interfaces described further herein and withregard to FIGS. 6A-6L.

In particular, health care system 100 is facilitated by the e-commerceplatform 101. For example, a consumer 102 may shop, place an order, payfor the order, see a provider, receive a notice of fulfillment, andsubmit a provider review through the e-commerce platform 101 without theneed to directly interact with any other entity in the health caresystem 100. The e-commerce platform 101 may place an order with aprovider 104 and receive an invoice therefrom.

The e-commerce platform 101 may receive balance information for a healthsavings account (HSA) from a financial institution 106. If funds from anHSA are applied to the purchase of a health care service bundleindicator, funds are transferred between the financial institution 106and the payment processor 105. E-commerce platform 101 provides thepayment processor 105 a consumer payment and a provider payment. In someexamples, the payment processor 105 is a part of the e-commerce platform101.

Medical claims clearinghouse 107 interfaces with the plan administrator103, the provider 104, the payment processor 105, and the e-commerceplatform 101. In some examples, the clearinghouse 107 and the e-commerceplatform 101 may directly communicate regarding eligibility inquiries,claims, and electronic remittance advice.

Health bundle indicators are formed using a national data set of themost common CPT codes associated with planned and predictable, routinehealth care services. These CPT codes are grouped to form common bundlesof care. Health bundle indicators are loaded into the e-commerceplatform along with the average prices of these bundles of care byregion. Providers 104 can select which health care service bundleindicators to offer on the platform and offer the default average priceor set their own price. Providers will compete in this open e-commercemarketplace on price and quality, driving down the costs associated withthese services. Consumers 102 will be able to shop by price and qualityfor these standardized services, where a particular health care servicebundle indicator is the same offering regardless of provider. Consumers102 can purchase the health care service bundle indicator on thee-commerce platform 101. Health care service bundle indicators aredescribed further herein and with regard to FIGS. 2A-2B.

Providers would like to simplify their administrative processes,particularly the bill review cycle, and eliminate claims complexity.Providers would like to improve their cash flow and reduce patientreceivables. Consumers would also like to eliminate the uncertainty orsurprise of unexpected bills associated with services received.

Thus, systems and methods are provided for making bundles of care looklike a health care service bundle indicator to consumers, procedure anddiagnosis codes to providers, and auto-adjudicated claims to a TPA. Thee-commerce platform eliminates the normal processing overhead associatedwith claims, instead issuing receipt documentation, referred to hereinalso as an EHEALTHRECEIPT™, for services rendered. This receiptdocumentation will be issued to consumers while also beingauto-adjudicated by their insurer to apply against their health plandeductible. Consumers will no longer have to receive or reconcile billsfrom their provider and their health plan's Explanation of Benefits(EOB) statement.

The e-commerce platform 101 enables providers to set their own fees andattract insured patients. Money from consumers will be placed intoescrow and transfers between an account at financial institution 106 andthe payment processor 105 will be configured before services arerendered, ensuring prompt payment to providers for patient services withno financial risk, reducing their patient receivables and improvingtheir cash flow.

When health care consumers 102 register on the e-commerce platform 101,it confirms their eligibility in real time. The e-commerce platform 101submits an eligibility inquiry to the plan administrator 103, and theplan administrator 103 returns a response. Consumers pay at the point ofpurchase on the e-commerce platform 101, and funds are released from thepayment processor 105 to a provider 104 once the provider 104 confirmsthat purchased services were rendered by submitting an invoice, orclaim. This eliminates the need for providers 104 to file a claim to aplan administrator 103 and for any surprise bills to consumers 102. Oncethis verification takes place, the information is released by thee-commerce platform 101 to the plan administrator 103 in the form of aclaim, or receipt documentation, with a high probability ofauto-adjudication. The plan administrator 103 processes the claim andapplies it against the consumer's deductible. Example methods forbilling are described further herein and with regard to FIGS. 7-8 .

Health care professionals provide care to consumers and bill for theseservices using Current Procedural Terminology (CPT) codes that describethe medical procedures and physicians services provided to the patient.The consumer is not aware of the cost of these services before visitingthe physician and health care services are highly variable acrossproviders, making shopping for services difficult. Thus, systems andmethods are provided for shopping, purchasing, and fulfilling normalizedhealth care services from health care professionals online. E-commerceplatform 101 provides a simple and easy way to understand, access,compare, and purchase care before appointment. The present inventionrelates to an improved process where planned and predictable health careservices are purchased and consumed at known prices. Hence, ane-commerce health care marketplace is provided where consumers shop andpay for planned and predictable health care services at known prices.The e-commerce platform 101 helps consumers spend their limited healthcare dollars wisely by delivering transparent quality and costinformation.

The e-commerce platform 101 enables health care consumers to: shop forhealth care services; shop and compare providers based on price,quality, and patient reviews; see where they stand with deductibles andcalculate out-of-pocket costs; and order a service and pay for it usinga personal credit/debit card or an HSA, FSA, or HRA account. Paymentsare processed and applied to deductibles after services are rendered,eliminating surprise bills later. Consumers can also access a nurse lineor telehealth providers to seek help in finding the right health careservice. Example methods and interfaces for health care consumers aredescribed further herein and with regard to FIGS. 5-6L.

Consumers might need guidance when purchasing health care services. Asfirst time shoppers in health care, they will want to know which typesof services are often purchased together and what kind of modificationsto their purchase might take place at the provider's office. They willneed clarity that they are purchasing the right services at the righttime. Thus, systems and methods are provided for the formation of apersonalization engine. Similar to the online shopping sites consumersalready use for products, consumers will receive recommendations forservices based on their past purchases and the purchases of otherconsumers. Consumers will be able to see which health care servicebundle indicators are commonly purchased together, and whatmodifications and add-ons might take place at the point of service. Anexample personalization engine is described further herein and withregard to FIG. 9 .

FIG. 1B schematically shows a non-limiting computing system 110 that mayperform one or more of the methods and processes described herein. Asdescribed hereinabove, any of the components shown in FIG. 1A maycomprise computing system 110. It is to be understood that virtually anycomputer architecture may be used for a computing device withoutdeparting from the scope of this disclosure. In different embodiments,computing system 110 may take the form of a mainframe computer, servercomputer, desktop computer, laptop computer, tablet computer, homeentertainment computer, network computing device, mobile computingdevice, mobile communication device, gaming device, etc.

Computing system 110 includes a logic subsystem 113 and a data-holdingsubsystem 115. Computing system 110 may optionally include a displaysubsystem 117, communication subsystem 119, and/or other components notshown in FIG. 1B. For example, computing system 110 may also optionallyinclude user input devices such as keyboards, mice, game controllers,cameras, microphones, and/or touch screens.

Logic subsystem 113 may include one or more physical devices configuredto execute one or more instructions. For example, logic subsystem 113may be configured to execute one or more instructions that are part ofone or more applications, services, programs, routines, libraries,objects, components, data structures, or other logical constructs. Suchinstructions may be implemented to perform a task, implement a datatype, transform the state of one or more devices, or otherwise arrive ata desired result.

Logic subsystem 113 may include one or more processors that areconfigured to execute software instructions. Additionally oralternatively, the logic subsystem 113 may include one or more hardwareor firmware logic machines configured to execute hardware or firmwareinstructions. Processors of the logic subsystem 113 may be single coreor multi-core, and the programs executed thereon may be configured forparallel or distributed processing. The logic subsystem 113 mayoptionally include individual components that are distributed throughouttwo or more devices, which may be remotely located and/or configured forcoordinated processing. One or more aspects of the logic subsystem 113may be virtualized and executed by remotely accessible networkedcomputing devices configured in a cloud computing configuration.

Data-holding subsystem 115 may include one or more physical,non-transitory devices configured to hold data and/or instructionsexecutable by the logic subsystem 113 to implement the herein describedmethods and processes. When such methods and processes are implemented,the state of data-holding subsystem may be transformed (for example, tohold different data).

Data-holding subsystem 115 may include removable media and/or built-indevices. Data-holding subsystem 115 may include optical memory (forexample, CD, DVD, HD-DVD, Blu-Ray Disc, etc.), and/or magnetic memorydevices (for example, hard disk drive, floppy disk drive, tape drive,MRAM, etc.), and the like. Data-holding subsystem 115 may includedevices with one or more of the following characteristics: volatile,nonvolatile, dynamic, static, read/write, read-only, random access,sequential access, location addressable, file addressable, and contentaddressable. In some embodiments, logic subsystem 113 and data-holdingsubsystem 115 may be integrated into one or more common devices, such asan application specific integrated circuit or a system on a chip.

It is to be appreciated that data-holding subsystem 115 includes one ormore physical, non-transitory devices. In contrast, in some embodimentsaspects of the instructions described herein may be propagated in atransitory fashion by a pure signal (for example, an electromagneticsignal, an optical signal, etc.) that is not held by a physical devicefor at least a finite duration. Furthermore, data and/or other forms ofinformation pertaining to the present disclosure may be propagated by apure signal.

When included, display subsystem 117 may be used to present a visualrepresentation of data held by data-holding subsystem 115. As the hereindescribed methods and processes change the data held by the data-holdingsubsystem 115, and thus transform the state of the data-holdingsubsystem 115, the state of display subsystem 117 may likewise betransformed to visually represent changes in the underlying data.Display subsystem 117 may include one or more display devices utilizingvirtually any type of technology. Such display devices may be combinedwith logic subsystem 113 and/or data-holding subsystem 115 in a sharedenclosure, or such display devices may be peripheral display devices.

When included, communication subsystem 119 may be configured tocommunicatively couple computing system 110 with one or more othercomputing devices. Communication subsystem 119 may include wired and/orwireless communication devices compatible with one or more differentcommunication protocols. As non-limiting examples, communicationsubsystem 119 may be configured for communication via a wirelesstelephone network, a wireless local area network, a wired local areanetwork, a wireless wide area network, a wired wide area network, etc.In some embodiments, communication subsystem 119 may allow computingsystem 110 to send and/or receive messages to and/or from other devicesvia a network such as the public Internet.

FIG. 1C shows a high-level diagram illustrating an example health caresystem 120 in accordance with the current disclosure. In particular,diagram 120 provides a zoomed-in, detailed view of a portion of healthcare system 100 with a focus on information flow between the e-commerceplatform 121 and the consumer 122, a financial institution 125, aprovider 124, a plan administrator 123, and a reportingsystem/clearinghouse 126.

Consumer 122 may interact with the e-commerce platform 121 to provideand retrieve account information, schedules, and payments. Similarly,the provider 124 may interact with the e-commerce platform 121 toprovide and retrieve schedules and payments. To further facilitatepayment to the provider 122, the e-commerce platform 121 may retrieve anaccount balance, such as an HSA balance, from the financial institution125.

E-commerce platform 121 additionally interacts with a plan administrator123, where the plan administrator 123 administers claims processing fora health care plan of the consumer 122. To that end, plan administrator123 includes an electronic data interchange (EDI) system 127, claimsystem 128, reporting system 129, output system 130, servicing system131, and finance system 132. The e-commerce platform 121 interacts withplan administrator 123 via EDI system 127. Specifically, the e-commerceplatform 121 exchanges eligibility information and claim informationwith the EDI system 127. Claim system 128 processes the claiminformation received via the EDI system 127, output system 130 preparesoutput based on the processed claim information. Servicing system 131and reporting system 129 handle administration of the processed claiminformation. For example, reporting system 129 communicates with financesystem 132, which may further communicate with e-commerce platform 121,to facilitate payments to the provider 124 based on the claiminformation. Reporting system 129 may further communicate withclearinghouse 126, which may also separately receive eligibilityinformation and claim information from e-commerce platform 121, suchthat the clearinghouse 126 may process and standardize reports.

FIG. 1D shows a high-level diagram illustrating an example architecture140 for an e-commerce platform in accordance with the currentdisclosure. Architecture 140 includes a plurality of modules configuredto provide the functionality of an e-commerce platform, such ase-commerce platform 101 described herein above with regard to FIG. 1A.The plurality of modules may include, but are not limited to, a portalsmodule 141, a customer/supplier management module 142, an inventorymanagement module 143, an e-commerce module 144, an order fulfillmentmodule 145, an integration module 146, a data management module 147, andan analytics and reporting module 148.

Portals module 141 provides interfaces that enable users of thee-commerce platform to interact with other modules of the plurality ofmodules 150. Example interfaces that may be provided by portals module141 are described further herein.

Customer/supplier management module 142 provides campaign management,employer onboarding, provider onboarding, contract management, billing,portal, and a concierge. Consumer onboarding is described further hereinwith regard to FIGS. 5-6L, and provider onboarding is described furtherherein with regard to FIGS. 3A-4F.

Inventory management module 143 provides a provider profile, servicecatalog, pricing, content management, and tax configuration.

E-commerce module 144 provides multiple storefronts for health careservices, each providing interfaces for shopping, reviews, promotion,payment, tax calculations, plan/patient calculations, and giftcertificates. The e-commerce module further includes shopping tools,such as calculators, health information, quality information, andtransparency tools. The e-commerce module 144 also provides a mobilenative application that enables a health care consumer to interact withthe e-commerce platform through a mobile device.

Order fulfillment module 145 provides order management, invoicing,provider payments, and plan submissions.

Integration module 146 provides interfaces for communicating withsystems external to the e-commerce platform, including but not limitedto provider systems 161, clearinghouses 162, benefit plans (e.g., viathird-party administrators or TPAs) 163, and financial institutions 164.

Data management module 147 includes a plurality of databases 150,including one or more databases for each of an employer 151, provider152, consumer 153, health plan, TPA, catalog 154, orders 155, andexternal data 156. Architecture 140 further includes an analytics andreporting module 148 for analyzing internal and external data as well asgenerating reports for internal and external review.

The systems described herein above with regard to FIGS. 1A-1D enable asimplified method for facilitating the selling and purchasing of healthcare services with an e-commerce platform. Specifically, such a methodrelates to the purchasing of prepackaged health care services prior toreceiving the health care services from a health care provider. In thisway, prices for health care services may be lowered due to competition,providers may receive payment more quickly for services rendered, andhealth care consumers may shop for health care without being surprisedby a health care bill weeks after receiving a health care service.

As an illustrative example, providers may list services and prices forthe services using the e-commerce platform. The marketplace provided bythe e-commerce platform leads to competitive pricing for health careservices, as health care providers may view the prices for health careservices offered by each other and compete for health care consumers.Methods and interfaces for health care providers provided by thee-commerce platform are described further herein and with regard toFIGS. 3A-4F.

Health care consumers may shop for health care services by comparing andchoosing needed care. The e-commerce platform integrates with healthcare benefits to display the deductible impact to the health careconsumer. A health care consumer may lock in the price of a chosenhealth care service with a health savings account (HSA), a flexiblespending account (FSA), and/or a debit or credit card. Methods andinterfaces for consumers pre-purchasing health care services aredescribed further herein and with regard to FIGS. 5-6L.

The payment for health care services is securely held until care isreceived by the health care consumer. After the health care consumer andprovider connect and care is delivered, receipt documentation is sent toa claims administrator in a format compliant with official standards,and payment is sent to the health care provider. The receiptdocumentation is also sent to the consumer in a user-friendly format.Methods and interfaces for a billing system are described further hereinand with regard to FIGS. 7-8 .

Consumers need a way to shop for and compare health care services in astandardized way. Today, provider services and pricing are highlyvariable, and consumers cannot easily compare services because ofvariations in CPT codes when shopping for and selecting these services.Thus, systems and methods for the formation of a standardized bundle ofcare that can be stocked and sold in an e-commerce marketplace aredescribed further herein with regard to FIGS. 2A-2B. The goal of thestandardized bundle of care, or health care service bundle indicator, isto curate the health care service shopping experience in a way that ismeaningful and easily understood by the consumer. This health careservice bundle indicator comprises a defined set of CPT codes,modifiable by provider, with associated average regional pricing. Thehealth care service bundle indicator will be stocked by providers on ane-commerce platform and purchased by consumers.

Health bundle indicators are generated using a national data set of themost common CPT codes associated with planned and predictable, routinehealth care services. These CPT codes are grouped to form common bundlesof care. Health bundle indicators are loaded into the e-commerceplatform along with the average prices of these bundles of care byregion. Providers can select which health care service bundle indicatorsto offer on the platform and offer the default average price or settheir own price. Providers will compete in this e-commerce marketplaceon price and quality, driving down the costs associated with theseservices. Consumers will be able to shop by price and quality for thesestandardized services, where a particular health care service bundleindicator is the same offering regardless of provider. Consumers canpurchase the health care service bundle indicator on the e-commerceplatform.

FIG. 2A shows a high-level diagram illustrating an example method 200for bundling health care services into a health care service bundleindicator. Such standardized bundles of care may be considered a healthcare service bundle indicator, which is similar to a stock keeping unit(SKU), commonly used in inventory management to denote a specific itemfor sale. As described herein below, a health care service bundleindicator may comprise information regarding specific health careservices as well as additional information that may inform the price ofthe health care service bundle indicator, such as region and specificprovider. Thus method 200 particularly relates to the bundling of healthcare services informed by claims and other data and the representationof such bundles using health care service bundle indicators.

An e-commerce platform 201, such as the e-commerce platform 101described herein above, may form and refine standardized bundles ofhealth care services based on historic and current data. For example,the e-commerce platform 201 may obtain national claims information froma national claims database 202. In particular, the e-commerce platformmay identify engagements of care from the data 202, which may bedelivered to the e-commerce platform 201 in the form of, say, an Exceldocument. The e-commerce platform 201 may further obtain metadata froman internal e-commerce platform database 204, where such metadata maycomprise, for example, order information, provider listings, fulfillmentdata, and CPT and ICD-9/10 data.

After identifying and refining bundles of services, the e-commerceplatform 201 may generate an identifier, or health care service bundleindicator 206, for each bundle by applying a taxonomy to the bundle. Inone example, a health care service bundle indicator taxonomy maycomprise a service category, service group, service type, location, andsingle unit code, where the service category may correspond to a broadhealth care service category, the service group may correspond to asubset of services within the broad health care service category, theservice type may correspond to a specific set of services within thegroup, the location may correspond to a geographical region or a healthcare practice where the service may be rendered, and the single unitcode may encode additional information such as a specific provider.

The health care service bundle indicator taxonomy may enable a healthcare service bundle indicator to clearly identify a specific bundle ofhealth care services so that health care providers may easily associatea price with a health care service bundle indicator and health consumersmay easily understand what services are offered by a health careprovider. For example, one component of a health care service bundleindicator taxonomy may comprise a health care service category. Examplesof service categories may include, but are not limited to, primary care,imaging, therapy, vaccinations, dental, vision, hearing, labs,complementary and alternative medicine (CAM), and so on. Each servicecategory may contain one or more health care service groups. Forexample, a primary care service category may include service groups suchas wellness exams and minor illness or injury visits. An imaging servicecategory may include service groups such as mammograms, x-rays,ultrasounds, and MRIs. A therapy service category may include servicegroups such as physical therapy, occupational therapy, and speechtherapy. A vaccinations service category may include service groups suchas flu shots, chicken pox, MMR, and Hepatitis A and B. A dental servicecategory may include service groups such as exams and cleanings. Avision service category may include service groups such as eye exams,vision tests, and contact lens fittings. A CAM service category mayinclude service groups such as chiropractic exams, acupuncture sessions,and massage sessions. As described further herein, each service groupmay include one or more bundles of health care services, or servicetypes, related to the service group.

Thus a health care service bundle indicator comprises a specific bundleof health care services and may be denoted by a distinctive identifier.To form a distinctive health care service bundle indicator identifier, acode may be assigned to each category relating to the health careservice bundle indicator. The format of a health care service bundleindicator may comprise any combination of codes according to a specifiedtaxonomy that identifies a bundle of care. For example, each servicegroup may be assigned a three-letter code and each service bundle may beassigned a two-digit code that is within the service group. Acombination of a service group code and a service bundle code may form aproduct code, referring to a particular combination of health careservices. Further, each location where a service can be delivered mayfurther be assigned a three-letter code, and each provider who offers aservice on the marketplace may be assigned a three-letter code. A healthcare service bundle indicator identifier may thus be constructed byconcatenating the location code to the provider code and the productcode.

In some examples, a health care service bundle indicator may represent aspecific set of health care services offered by a specific provider. Forexample, within a preventative care category, a service group maycomprise a wellness exam denoted by the three-letter code WEL. Aparticular service within the wellness exam service group may comprise agroup of common procedure terminology (CPT) codes, for example “Men'sWellness Exam, Age 60-64, Established Patient, History of IncreasedBlood Pressure, With Screening Colonoscopy” may be the plain languageequivalent of the CPT codes 99396, 82947, 80061, and 60121. Thisparticular combination of services may be assigned a two-number code,for example 17. Therefore the product code for this service may beWEL17. As described hereinabove, a health care service bundle indicatormay include such a product code in addition to codes identifying aspecific provider. For example, a provider location code for the NWDoctors Group located at 1234 SW Market Street in Portland, Oreg. may bedenoted by NWD, while a provider code for a specific health careprovider, say Dr. John Doe, working at the provider location may bedenoted by the three-letter code JDO. Therefore the health care servicebundle indicator for the specific preventative care service bundledescribed above offered by Dr. John Doe at the NW Doctors Group may beNWDJDOWEL17.

As another example, a service group within an imaging category maycomprise a mammogram denoted by the three-letter code MAM. A particularservice within this service group may comprise a group of CPT codes, forexample “Screening mammography producing direct digital image pluscomputer aided detection” may be the plain language equivalent of theCPT codes 60202 and 77052. This particular combination of services maybe assigned a two-number code, for example 02. Therefore the productcode for this particular bundle of services may be MAM02. A particularprovider location, for example the PDX Imaging Center at 5555 HawthorneBoulevard in Portland, Oreg., may be a three-letter code, for examplePIC. A particular provider working at the particular provider location,say Dr. Jane Smith, may be assigned a three-letter code, for exampleJAS. Therefore the health care service bundle indicator for the specificimaging service bundle described above offered by Dr. Jane Smith at thePDX Imaging Center may be PICJASMAM02.

As yet another example, a service group within a primary care categorymay comprise an illness or injury visit denoted by the three-letter codeNNV. A particular service within this service group may comprise a groupof CPT codes, for example “Sore throat/possible strep throat—establishedpatient” may be the plain language equivalent of the CPT codes 99213 and87880. This particular combination of services may be assigned atwo-number code, for example 04. Therefore the product code for thisparticular bundle of services may be NNV04. A particular providerlocation, for example Doctor Now at 7 Division Street in Portland,Oreg., may be a three-letter code, for example DNW. A particularprovider working at the particular provider location, say Dr. MelissaJones, may be assigned a three-letter code, for example MJS. Thereforethe health care service bundle indicator for the specific primary careservice bundle described above offered by Dr. Melissa Jones at DoctorNow may be DNWMJSNNV04.

As another example, a service group within a primary care category maycomprise an illness or injury visit denoted by the three-letter codeNNV. A particular service within this service group may comprise a groupof CPT codes, for example “Minor condition office visit, new patient”may be the plain language equivalent of the CPT code 99203. Thisparticular combination of services may be assigned a two-number code,for example 01. Therefore the product code for this particular bundle ofservices may be NNV01. A particular provider location, for exampleDoctor Now at 7 Division Street in Portland, Oreg., may be athree-letter code, for example DNW. A particular provider working at theparticular provider location, say Dr. James Robinson, may be assigned athree-letter code, for example DJR. Therefore the health care servicebundle indicator for the specific illness or injury visit service bundledescribed above offered by Dr. James Robinson at Doctor Now may beDNWDJRNNV01.

As yet another example, a health care service bundle indicator maycomprise a sequence of alphanumerical characters following the patternXXX-XXXX-XXX. For example, the first segment of the sequence (i.e., thethree characters before the first dash) may refer to a service bundle,wherein a specific combination of alphanumeric characters refers to aspecific combination of CPT codes. The second segment of the sequence(i.e., the four characters after the first dash and before the seconddash) may refer to a provider, wherein a specific combination ofalphanumeric characters refers to a specific provider of the servicebundle. The second segment may further refer to an applicable providernetwork. For example, a doctor may be contracted for price A for aparticular service under an HSA plan, but may also be contracted forprice B for the same particular service under a copay plan. Thus, thesecond segment may include additional information related to theprovider in order to correctly identify the contracted price for aservice. The third segment of the sequence (i.e., the three charactersafter the second dash) may refer to a location. In some examples, thesequence of the third segment may have a specified relation to thegeographic market. However, in other examples, the sequence of the thirdsegment may be system generated; for example, the sequence may be basedon the order in which a location is set up in the e-commerce platform.The list of valid alphanumeric characters may include 0-9 and A-Z. Insome examples, the list of valid alphanumeric characters may be a subsetof the aforementioned list for the purpose of distinguishability. Forexample, the list of valid alphanumeric characters may include 2-9 andA-Z (excluding “0”) in order to exclude 0, 1, and 0 because 0 and 0 maybe difficult to distinguish and 1 and I may be difficult to distinguish.The alphanumeric characters may further be ordered such that the lowestvalue character is 2, for example, and the highest value character is Z.Thus the lowest possible health care service bundle indicator may be222-2222-222, while the highest possible health care service bundleindicator may be ZZZ-ZZZZ-ZZZ. Furthermore, the number of characters andsegments may vary. For example, the health care service bundle indicatormay include more than three segments in the sequence, and each sequencemay include any suitable number of characters to uniquely identify aservice bundle offered by a provider in a geographical region.

Thus any taxonomy capable of uniquely identifying a bundle of care maybe utilized to construct a unique identifier of a health care servicebundle indicator. As described above, one taxonomy may specify aparticular bundle of care delivered in a geographical region, whileanother taxonomy may specify a particular bundle of care delivered by aspecific provider.

Bundling a set of health care services into a product code allowsproviders to set a price for a product code—thereby generating a healthcare service bundle indicator— and allows health care consumers tosearch for health care services by product code and compare the healthcare service bundle indicators associated with each provider. Byencouraging providers to offer a specific bundles of health careservices associated with specific product codes, consumers mayexperience consistency among providers when shopping for health careservices and prices.

FIG. 2B shows a high-level diagram illustrating an example method 220for bundling health care services into a health care service bundleindicator. In particular, method 220 relates to the automatic generationof receipt documentation and a health care claim from a purchased bundleof care. A provider bundle 226 may be formed based on a plurality of CPTcodes 222 most often added to health care services and a taxonomy 224,such as the taxonomy described herein above. The provider bundle 226 maytherefore comprise a standard service 227 which may comprise a pluralityof CPT codes, for example CPT code A, CPT code B, and CPT code C. Theprovider bundle 226 may include additional CPT codes, such as CPT code Dand CPT code F, in addition to the standard service 227. Theseadditional CPT codes may be selected, as non-limiting examples, by theprovider and/or the consumer, or may be selected based on the taxonomy224. The provider bundle 226 may comprise and/or may be represented by ahealth care service bundle indicator which uniquely identifies theprovider bundle.

A health care consumer may purchase the provider bundle 226 from aparticular provider in a single order 230. Thus the single order 230 maycomprise the purchased service (i.e., the provider bundle 226), userinformation identifying the health care consumer, and providerinformation identifying the particular provider. The providerinformation may further include information identifying an applicableprovider network, so that the price of the health bundle offered to aconsumers in the e-commerce marketplace may vary based on which networkthe provider is contracted with since individual health plans areaffiliated with specific provider networks.

Based on the single order information, the e-commerce platform maygenerate receipt documentation 232 for the consumer, where the receiptdocumentation 232 comprises purchased service information (e.g., adescription of the service in non-technical terms), providerinformation, and user information. Additionally, a claim 234 may begenerated based on the single order 230 after fulfillment of the order.The claim 234 may include a technical description of the servicesprovided in a standardized format. For example, the claim 234 mayinclude a plurality of CPT codes associated with the provided services,additional medical classifications (e.g., ICD-10), user insuranceinformation, and provider information.

FIG. 3A shows a high-level flow chart illustrating an example method 300for enrolling a health care provider into an e-commerce health careplatform. The method will be described herein with reference to thesystems and components depicted in FIGS. 1A-1D, however it should beappreciated that the method may be carried out by other systems andcomponents without departing from the scope of the disclosure.

Method 300 begins at 302, when a provider connects to the e-commerceplatform. At 302, the e-commerce platform 302 may provide, to acomputing device of the provider, a provider-specific landing page fordisplay to the provider.

At 304, the method includes determining if the provider has an accountwith the e-commerce platform. If the provider has an account (“Y”),method 300 proceeds to 306 where the e-commerce platform receives logincredentials for the provider. If the login credentials are valid, theprovider is logged into the provider account at 308. Once logged in, thee-commerce platform may provide a provider dashboard for display to theprovider, wherein the provider dashboard includes functionality for aprovider to view orders, confirm fulfillment of orders, view incomingand/or settled payments, and so on. The method may then end.

Returning to 304, if the provider does not have an account with thee-commerce platform (“N”), method 300 proceeds to 310. At 310, thee-commerce platform receives provider registration information. Providerregistration information may include practice information 312 comprisingdetails regarding the provider's practice (e.g., a clinic, hospital, andso on), and provider information 314 comprising details regarding theprovider. The provider registration information may further includeservices information 316 comprising details regarding which services theprovider will offer on the e-commerce platform. As described furtherherein, the provider may upload a fee schedule 317 which includes feesfor select services, which may be automatically processed by thee-commerce platform. Additionally or alternatively, the provider mayprovide manual input 318 regarding the services. Provider registrationinformation may further include payment information 320 comprising, forexample, details regarding a financial account of the provider intowhich funds may be transferred for services provided.

At 322, the e-commerce platform generates a provider account based onthe received provider registration information. After generating theprovider account, at 324 the e-commerce platform may provide a providerdashboard for display to the provider. The method may then end.

FIG. 3B shows a high-level flow chart illustrating an example method 330for adjusting fees for health care services. As described furtherherein, a provider may adjust fees for particular services offered onthe e-commerce platform at any time. The method will be described hereinwith reference to the systems and components depicted in FIGS. 1A-1D,however it should be appreciated that the method may be carried out byother systems and components without departing from the scope of thedisclosure.

Method 330 begins at 332, wherein the e-commerce platform displays aprovider dashboard to the provider. At 334, the method includesdetermining if the provider is attempting to edit service information.If the provider is not attempting to edit service information (“N”),then the method ends. However, if the provider is attempting to editservice information (“Y”), method 330 proceeds to 336. At 336, thee-commerce platform receives updated service and fee information. At338, the e-commerce platform updates the provider account with theupdated service and fee information. The method then ends.

FIG. 3C shows a high-level flow chart illustrating an example method 340for facilitating reporting of fulfilled services and payment for saidservices. The method will be described herein with reference to thesystems and components depicted in FIGS. 1A-1D, however it should beappreciated that the method may be carried out by other systems andcomponents without departing from the scope of the disclosure.

Method 340 begins at 342, wherein the provider dashboard is displayed tothe provider. At 344, the method includes determining if an order for ahealth care service is received. If no order is received (“N”), themethod ends. However, if an order is received (“Y”), then the orderinformation is displayed to the provider at 346. At 348, the methodincludes determining if the order is fulfilled. The provider isresponsible for confirming via the e-commerce platform that the order isfulfilled (i.e., that the provider has provided the services purchasedby a consumer to the consumer). If the order is not fulfilled (“N”),then the method ends. However, if the order is fulfilled (“Y”), thenmethod 340 proceeds to 350. At 350, the e-commerce platform facilitatesthe transfer of a payment to the provider. The payment may include theout-of-pocket cost paid by the consumer in addition to costs covered bya health care plan of the consumer. At 352, the e-commerce platform maygenerate receipt documentation to be provided to the consumer, as wellas claim documentation to be provided to an administrator of the healthcare plan, a clearinghouse, and so on. Method 340 then ends.

FIGS. 4A-4F illustrate example e-commerce health care platforminterfaces for a health care provider. In particular, interface 400 inFIG. 4A comprises a landing page for a health care provider. Interface400 includes a brief registration form and an overview of how thee-commerce platform marketplace functions.

After a provider fills out the registration form, a second interface isshown to the provider. The second interface includes a specific overviewof the information necessary to complete a provider account profile,such as practice basics, office locations, providers, paymentpreference, and services. The second interface further allows theprovider to add a colleague to the registration process to assist withsetting up the account.

A third interface includes a form for practice information. The form maycomprise inputs for a plurality of details regarding the practice,including a legal business name, a practice name, a business taxidentification number, an organization national provider identification(NPI) number, an address, contact information, and authorized personnelof the practice other than the provider who may use the e-commerceplatform.

A fourth interface includes a form for provider information. The formmay comprise inputs for a plurality of details regarding the provider,including name, gender, languages spoken, credentials, specialties,provider NPI number, and a biography.

After the provider enters information about the practice where he or sheworks, the location(s) of the practice, and the providers who work atthe practice including the provider setting up the account, the providermay set up the at least one service that the provider plans to sellthrough the e-commerce platform. A fifth interface shows multipleoptions for setting up at least one health care service, includinguploading a fee schedule, and a manual setup tool. In some examples, oneoption may include a guided walk-through wherein a representative of thee-commerce platform assists the provider, for example via a co-browsingsession, in setting up a service catalog.

Via a sixth interface, uploading a fee schedule in order to set up aservice may comprise uploading a file containing the provider's feeschedule for health care services. The sixth interface may allow aprovider to upload a fee schedule in any format, such as PDF, DOCX,XLSX, CSV, TXT, or an image file. The e-commerce platform uses theuploaded fee schedule to form a draft of a service catalog for theprovider, which may later be edited and approved by the provider priorto displaying the services in the e-commerce platform marketplace. Thesixth interface may further include registration information previouslyentered by the provider, including but not limited to the practiceinformation and provider information.

After setting up the services information, the provider may be promptedto input payment account information, for example via a seventhinterface. The seventh interface includes a form for payment accountinformation, which may include at least a tax identification number. Insome examples, the e-commerce platform may retrieve specific accountdetails based on the tax identification number. In other examples, theseventh interface may further include inputs for specific accountdetails.

After setting up the payment account information, a provider account maybe generated based on the information provided by the provider, and theprovider may be shown an eighth interface. The eighth interface mayinclude a notice indicating that the account is successfullyestablished, as well as an application summary comprising all of theinformation input by the provider.

If the provider opts to manually input service information as discussedabove instead of uploading a fee schedule, the provider may be shown aninth interface. The ninth interface includes a setup tool comprisingone or more drop-down menus containing selectable information. Forexample, the setup tool may include a category drop-down menu and aservice type drop-down menu so that the provider may setup a particularservice to offer through the e-commerce platform.

Once the provider selects a category and a service type, the e-commerceplatform may display a default list of procedures associated with theparticular category/service type combination, via a tenth interface. Forexample, as shown in interface 415 in FIG. 4B, the provider may select aprice or fee for each category/service type combination (i.e., for eachhealth care service bundle indicator). Interface 415 may display theaverage regional price for each bundle of procedures. Additionally oralternatively, interface 415 may display the average contracted rate forproviders in the region or simply the contracted rate/negotiated feeschedule with that provider (taking into account different networkaffiliations). In this way, the provider may select a fee for a specificproduct code in order to compete with other providers. In some examples,the provider may be required to offer a particular list of procedures inorder to qualify for an e-commerce platform account.

As described herein above with regard to FIG. 3B, the provider is notlimited to offering the services at the fees established when setting upthe account. As depicted in interface 430 of FIG. 4C, the provider mayadjust prices for each health care service bundle indicator by adjustingthe price for a specific procedure or CPT code, or by adjusting theprice for a bundle of procedures. In particular, interface 430illustrates how after a provider is enrolled in the e-commerce platform,the provider may adjust the price of a product code, or bundle of healthcare services, offered at any time. Interface 430 displays a list of theproduct codes offered by the provider, the price for each product codeset by the provider, and a comparison to the average regional price foreach product code. The provider may easily edit the price of a productcode via interface 430. The provider may decide to charge the averageregional price for a particular product code, or may decide to chargeless than the average regional price. As another example, the providermay choose to lower the price for new patient visits in order to enticeconsumers to purchase the provider's health care service bundleindicator. In this way, the price for each product code is at thediscretion of the provider, which may be influenced by competition inthe marketplace or by personal factors such as workload rather thancontractual agreements or arbitrary decisions. As a result of providersbeing able to view the average price of a product code as well as theprices offered by competing providers when adjusting the price of aproduct code, the costs of health care services may be loweredthroughout the health care marketplace.

Thus, systems and methods are provided for enrolling a health careprovider into an e-commerce platform for selling health care services inconvenient pre-bundled packages. In some examples, the provider mayprovide information regarding a health care practice and about otherproviders working at the same health care practice, such as location,name, contact information, office hours, and so on. Further, theprovider may use various methods to upload the health care services thatthe provider offers. For example, the provider may upload a fee schedulecontaining information about health care services offered and associatedfees, and this information may be automatically input by the e-commerceplatform or may be manually input by an e-commerce platformrepresentative. As another example, the provider may use a setup tool toinput health care services offered and input prices. As yet anotherexample, the provider may contact an e-commerce platform representative,who may then guide the provider through the setup process. The providermay input all health care services offered upon enrollment, or may inputat least one health care service upon enrollment and input additionalhealth care services offered at a later time. When the provider isinputting health care services offered and the associated price, thee-commerce platform may display an average regional price for a healthcare service. In this way, the provider may understand the market valueof a health care service, and may accordingly set a price based on theaverage regional price displayed. In some examples, the e-commerceplatform may provide a list of health care services that the providermust offer to be eligible to use the e-commerce platform. This list ofhealth care services may comprise the most common health care servicesoffered by other health care providers. In this way, the e-commerceplatform may encourage consistency for health care services offered byhealth care providers using the e-commerce platform.

FIG. 4D shows an example interface 445 for a provider to view purchasedorders. Interface 445 includes a list of orders placed by health careconsumers for health care services to be provided by the provider. Whenthe provider has fulfilled an order, the provider may select an orderfrom the list of orders to indicate that the order is fulfilled. When anorder is selected, the provider may be shown an interface such asinterface 460 in FIG. 4E, wherein the provider may input details such asthe date of service, an invoice number, an account number, procedurecodes for services provided, a quantity of the services provided,diagnosis codes, and so on. Once the provider enters the orderfulfillment information, the provider may receive payment for theprovided services. Thus, interface 460 may include a button to submitthe order, wherein the button indicates that the provider will get paidupon submission. Once the provider selects the button, the e-commerceplatform processes the order fulfillment and provides an interface suchas interface 475 in FIG. 4F. Interface 475 displays confirmation of afulfilled order, and thus includes information regarding the order suchas an order identification number, an order date, a status, a providerfee, a processing fee, a net amount paid to the provider, a servicedate, a submission date, a payment date, an invoice number, an accountnumber, and procedure and diagnosis codes for the provided services. Theinformation regarding the order may further include patient details,service details, provider details, and so on. Interface 475 may furtherindicate to the provider that the provider does not need to submit aclaim for the provided services, as the e-commerce platform performsthis function instead.

Thus, the e-commerce platform provides a plurality of user interfacesfor a health care provider to interact with the e-commerce platform. Viathese user interfaces, which may be displayed using a computing systemof the provider, the provider may enroll in the e-commerce platform,select health care services to offer via the e-commerce platform,establish fees for the selected health care services, edit the fees atany time, and manage orders placed by health care consumers.

As described further herein with regard to FIGS. 5-6L, the e-commerceplatform further provides methods and interfaces for health careconsumers.

FIG. 5 shows a high-level flow chart illustrating an example method 500for a health care consumer on an e-commerce health care platform. Inparticular, method 500 relates to how the e-commerce platform mayinteract with a health care consumer. Method 500 may be carried out, asa non-limiting example, by the e-commerce platform 101 described hereinabove with regard to FIGS. 1A-1D, though it should be understood thatthe method may be carried out by other systems without departing fromthe scope of the current disclosure.

Method 500 begins at 505, when a health care consumer or user connectsto the e-commerce platform. At 505, method 500 includes displaying alanding page. The landing page may, for example, resemble the userinterface 600 described herein below with regard to FIG. 6A, and mayprovide form inputs for the user to enroll in an e-commerce marketplaceor login to the e-commerce marketplace.

At 510, method 500 includes determining if the user has an e-commerceplatform account. If the user has an e-commerce platform account (“Y”),method 500 proceeds to 515. At 515, method 500 includes receiving theuser login credentials, which may comprise, as non-limiting examples, auser name and a password. Method 500 then proceeds to 535.

However, if the user does not have an e-commerce platform account (“N”),method 500 proceeds from 510 to 520. At 520, method 500 includesreceiving registration information. Registration information may includebiographical details of the user, health care benefits plan informationfor the user, financial information for the user, and so on.

At 525, method 500 includes generating a user account. The user accountmay be generated based on the received registration information. At 530,method 500 includes linking a health care plan to the user account.Specifically, the health care plan may be linked to the user accountbased on the health care benefits plan information included with thereceived registration information. Linking the health care plan to theuser account comprises performing an eligibility confirmation with, as anon-limiting example, an insurance administrator of the health careplan. That is, the e-commerce platform may submit an eligibilityverification request to the insurance administrator regarding whetherthe user is eligible for health care coverage and if so, the details ofcoverage such as which services are covered, deductible information, andso on. The insurance administrator verifies the eligibility of the user,and information received from the insurance administrator is stored inthe e-commerce platform so that further eligibility verification may notbe performed.

At 535, method 500 includes displaying a health care storefront. Thehealth care storefront may include a search tool which enables the userto search for health care services and providers based on geographiclocation. An example user interface for a health care storefront isdescribed further herein with regard to FIG. 6B.

At 540, method 500 includes receiving a query. The query may comprise ahealth care service or provider and a geographic location input to thesearch tool by the user. At 545, method 500 includes retrieving anddisplaying query results. The e-commerce platform searches one or moredatabases for the queried health care services and/or providers based onthe geographic location. Search or query results may then be displayedto the user. The query results may comprise a list of providers offeringthe health care services in the geographic location. Additionally oralternatively, the query results may comprise a list of health careservices offered by a queried provider. The user may then select aparticular combination of health care services and a provider, and placean order for the particular combination. Such a combination may berepresented in the e-commerce platform by a health care services bundleindicator which uniquely identifies the combination of health careservices and provider. As described further herein, the query resultsmay further include a cost breakdown of the health care services basedon fees provided by the health care providers as well as a health carebenefits plan of the user.

After the user places an order, at 550, method 500 includes receiving anorder. At 555, method 500 includes receiving payment. Payment for theorder may comprise an out-of-pocket cost to the user calculated based onthe provider fee and the health care benefits plan of the user. Theout-of-pocket cost may further be calculated based on a deductible ofthe user. The payment may be automatically withdrawn from a financialaccount of the user. Method 500 then ends.

FIGS. 6A-6L illustrate example e-commerce health care platforminterfaces for a health care consumer. Notably, the example interfacesfor a consumer illustrated in FIGS. 6A-6L are functionally differentfrom the example interfaces for a provider illustrated in FIGS. 4A-4F.

FIG. 6A includes an interface 600 comprising a landing page for a healthcare consumer. Interface 600 includes a brief registration form, a loginform, and an overview of the e-commerce platform features for a healthcare consumer. In some examples, the e-commerce platform may beavailable to a health care consumer through a health care plan offeredby an employer of the health care consumer. In such examples, theregistration form may require information identifying the health careconsumer as an employee of the employer. In some examples, such as thatdepicted in interface 600, the registration form may include form inputsfor a health care plan of the consumer so that the health care benefitsplan may be linked to an account of the consumer. For example, the formmay include inputs for name, gender, date of birth, contact information,health care plan member identification number, health care plan groupnumber, and so on. As described herein, the e-commerce platform may usethe health care consumer's health care benefits plan information todetermine eligibility for services as well as compute out-of-pocketcosts for the consumer based on the benefits.

In some examples, the health care consumer may register for an accountusing interface 600. As shown, interface 600 includes form inputs for auser account, including but not limited to user name, password, andcontact information.

After registering and/or logging into the e-commerce platform, thehealth care consumer may be shown an interface including an accountcreation confirmation to acknowledge the successful creation of a useraccount.

FIG. 6B shows an example interface 608 that comprises an e-commerceplatform storefront. As such, interface 608 may include, but is notlimited to, a search function for finding health care services andproviders, a link to obtain assistance with the e-commerce platform, alink to connect to a telehealth system so that the health care consumermay communicate with a health care professional over a secure video orphone line, a link to associate the account with the health careconsumer's health plan, health savings account (HSA), or healthreimbursement account (HRA), and so on.

After a health care consumer places a query, say for a specific type ofillness or health care service desired, using the search tool shown ininterface 608 of FIG. 6B, interface 616 in FIG. 6C may be displayed. Forexample, interface 608 may comprise a health care consumer's e-commerceplatform account home page, and illustrates how a consumer may utilizethe search function by entering a desired health care service type andlocation information, such as a zip code or city. After entering searchcriteria and clicking the search button, the e-commerce platformretrieves results based on the search criteria. Interface 616 shows oneexample of how search results may be displayed to a health careconsumer. The search results comprise a list of providers who providethe health care service that the consumer searched in the geographiclocation included in the query. Each result may include information suchas the price for the service offered by the provider, a quality ratingof the provider based on input from other health care consumers,information regarding the provider, and a comparison of the priceoffered by the provider to the average regional price. The price for theservice offered by the provider may comprise an out-of-pocket cost tothe consumer, which the e-commerce platform may determine based on, asnon-limiting examples, the consumer's health care plan (e.g.,deductible, contract rates, etc.), the applicable provider network, thefees established by the particular provider, and so on. As discussedabove, each of the services and corresponding fees for each provider inthe search results may be associated with a health care service bundleindicator that uniquely identifies the combination of service andprovider.

The health care consumer may view more information regarding the searchresults. For example, an additional interface may show a provider pagewhich includes, as non-limiting examples, the name of the provider, aphotograph of the provider, provider credentials, languages spoken,gender, practice location, services offered (including, as depicted, feeinformation for each service), user ratings, insurance status, and abiography of the provider.

Additionally or alternatively, the health care consumer may view moreinformation regarding a specific service offered by a particularprovider. For example, a separate interface may include a servicesummary for a selected health care service bundle. Said interface maydisplay pricing information for the selected health care service bundle,such as the provider price, an amount paid by the health care plan ofthe health care consumer, and the out-of-pocket cost. Said interface mayfurther display an average regional price for the selected health careservice bundle. Said interface may also display provider details andpractice details.

The interface may also include a “Purchase Now” button which enables thehealth care consumer to purchase the selected health care service bundlefor the listed out-of-pocket cost. For example, if the health careconsumer selects the “Purchase Now” button, the e-commerce platform mayprovide interface 624 in FIG. 6D to the consumer. Interface 624 includesan order overview of the selected health care service bundle. Interface624 may include form inputs so that the consumer may identify who willbe receiving the service. The consumer may also optionally select, viainterface 624, whether or not the e-commerce platform will submit aclaim for the service on behalf of the consumer. If the consumerdeclines to allow the e-commerce platform to submit a claim, then theconsumer may be responsible for 100% of the provider price and thepayment may not be applied to the consumer's deductible unless theconsumer submits a claim.

Interface 624 may further include a cost breakdown for the selectedservice bundle, including the provider price, the amount covered by thehealth care plan, and the out-of-pocket cost to the consumer. Interface624 may also display a co-insurance payment, for example. The consumermay select to cancel the order for the selected service or may proceedto payment. As depicted in interface 624, the consumer has not met ahealth care plan deductible and thus has a non-zero out-of-pocket cost.

As another example, interface 632 in FIG. 6E shows an order overview fora selected health care bundle wherein the health care plan does notcover the selected service. Thus, the cost breakdown indicates that theplan does not contribute to the cost of the service, so that theout-of-pocket cost to the consumer equals the full price of the serviceas established by the provider.

As yet another example, interface 640 in FIG. 6F shows an order overviewfor a selected health care bundle when the consumer has met a healthcare plan deductible. In this case, the health care plan covers the fullcost of the selected service, and the out-of-pocket cost to the consumeris zero. Thus, the e-commerce platform may determine an out-of-pocketcost based on the health care benefits plan of the consumer, taking intoaccount a deductible, so that the consumer may know prior to receivingthe service how much the service will personally cost. This function ofthe e-commerce platform provides a distinct advantage over previousmethods and systems for purchasing health care services, wherein aconsumer often does not know how much he or she will pay out-of-pocketfor any given health care service until after the health care service isprovided.

Thus, the e-commerce platform may obtain detailed benefits informationfrom a consumer's health care plan and apply such benefits informationto a cost to a consumer for a health care service bundle indicator atthe point of purchase. Furthermore, this information may be clearlydisplayed to a health care consumer at the point of purchase so that heor she may understand the coverage received and the amount dueout-of-pocket.

If the health care consumer chooses to proceed with payment for aselected service, interface 648 in FIG. 6G may be displayed to theconsumer. Interface 648 includes form inputs that enable the consumer toselect a payment option. As depicted, payment options may include, butare not limited to, an HSA card or any suitable debit/credit card.Interface 648 may further include form inputs to select a billingaddress. Interface 648 may further include an order overview asdescribed above.

After selecting a payment option, the health care consumer may select abutton to securely submit payment for the health care service bundle. Ifthe button is selected, the e-commerce platform processes the payment(or alternatively, coordinates with a payment processor to securelyprocess the payment) which comprises the out-of-pocket cost to theconsumer. Interface 656 in FIG. 6H may then be displayed to theconsumer. Interface 656 includes an order confirmation for the purchasedservice bundle, and may include an order identification number, date ofpurchase, information regarding the service purchased, the out-of-pocketcost paid for the service, a cost breakdown, and information regardinghow to schedule an appointment with the provider for the purchasedservice bundle. Assistance may be offered for setting up an appointmentthrough the e-commerce platform. For example, a telephone hotline ormessaging service may be provided by interface 656 for the consumer tocontact a representative for the e-commerce platform who may assist theconsumer in arranging the appointment.

After purchasing a service bundle, the health care consumer may viewpurchased orders, for example, via interface 664 of FIG. 6I. Interface664 includes an overview of order history so that the consumer may havea record of purchased services. Interface 664 may also include a statusof each order, wherein the status indicates whether the service has beenfulfilled.

After placing an order for a health care service bundle, the consumerschedules an appointment with the provider, visits the provider, andreceives the purchased service. When visiting the provider, the consumerdoes not need to pay because the out-of-pocket costs to the consumerwere purchased in advance. After the order is fulfilled, the consumerreceives receipt documentation regarding the fulfilled service.Interface 672 in FIG. 6J shows example receipt documentation. Inparticular, the receipt documentation may include a plurality ofinformation regarding the fulfilled order, including but not limited tomember (consumer) information, health plan information, a paymentsummary, customer transactions (e.g., payments by the consumer), aservice summary, patient details, provider details, claim information(e.g., procedure codes, procedure summaries, diagnoses, etc.), and soon. In some examples, the receipt documentation may further include adescription of the services in user-friendly language.

As discussed above, in some examples the health care consumer may linkHSA/HRA account information with the e-commerce platform account.Interface 680 in FIG. 6K shows an example account overview, includinginformation regarding linked plans such as health plan information andHSA/HRA account information. Interface 680 further includes a visualindicator of progress towards a deductible and transaction history.

Interface 680 in FIG. 6K allows a health care consumer to manage thee-commerce platform account for the consumer. To that end, interface 680may include information regarding the user account, as well asinformation regarding the health care benefits plan. The health carebenefits plan information may be automatically retrieved from, forexample, a third-party administrator of the health care benefits plan,rather than the consumer. For example, interface 680 may displayinformation from the linked accounts and displays relevant informationregarding the accounts. For example, if the consumer links a health careplan to the e-commerce platform account, interface 680 may display anoverview of the health care plan as well as progress towards adeductible. Further, interface 680 may include forms for linking theconsumer's existing health plan and HSA/HRA to the consumer's e-commerceplatform account. If the consumer links an HSA or HRA to the e-commerceplatform account, interface 680 may display an overview of the HSAand/or HRA, including balance information and contribution information.In this way, a health care consumer may easily access informationregarding his or her health care accounts. In some examples, interface680 may further display an e-commerce platform transaction history,which may include previous orders applied to one of the consumer'shealth care accounts.

In some examples, the e-commerce platform may provide additionalinterfaces that include advanced search functions for refining thesearch results. For example, a health care consumer may refine thesearch by limiting the results to providers in the network, providersout of the network, providers that may accept HSA payment, and so on.Search results may be further refined by price range, distance, qualityrating, and so on. The search result interfaces may further displayinformation from the consumer's linked health care accounts so that theconsumer may have information such as deductible and account balance onhand when choosing a particular health care provider. The pricesdisplayed may take the consumer's health care plan deductible intoaccount, so that the prices displayed comprise the out-of-pocket cost tothe consumer.

Each search result interface may further include an option to comparesearch results, or providers. For example, if three search resultsappeal to a health care consumer, the consumer may select the threeresults for comparison. Interface 688 shown in FIG. 6L includes acomparison of providers selected via the search results interface.Detailed information regarding each provider may be displayedside-by-side for easy comparison, such as the price, how long eachprovider may take to provide the service, the distance of the providerfrom the consumer, the quality rating based on patient reviews, thespecialty of the provider, the languages spoken by the provider, thehours that the provider is available, and so on. Interface 688 mayfurther include options to immediately add a service from a particularprovider to the consumer's e-commerce shopping cart.

As described hereinabove, a health care consumer may link his or herhealth care plan and/or HSA/HRA accounts to his or her e-commerceplatform account. In this way, when a health care consumer purchases ahealth care service bundle indicator on the e-commerce platform, theup-front out-of-pocket price of the health care service bundle indicatormay be based on the health care plan coverage and the consumer may useHSA/HRA funds to purchase the health care service bundle indicator.

Thus, a method for an e-commerce platform begins when a care seeker, orhealth care consumer, submits an order for a health care service bundleindicator. After submitting an order, the health care consumer maysimply visit a clinic if the clinic is a walk-in clinic, or may make anappointment to visit a non-walk-in clinic. To make an appointment, thehealth care consumer may either contact the provider directly toschedule an appointment, or may contact an e-commerce platformrepresentative who may assist in scheduling the appointment. Once theappointment is scheduled, the health care consumer visits the clinic atthe appointed time. Note that all actions relevant to the health careconsumer are grouped within a box.

In some examples, if the consumer decides to cancel the order prior tothe appointment, the consumer may log in to the e-commerce platform andcancel the order. The order may be cancelled immediately by thee-commerce platform and the payment refunded to the consumer without anyfees or penalties imposed for doing so. In examples where the consumerhas already made an appointment with a provider, the consumer isresponsible for contacting the provider to cancel the appointment.

Once the health care consumer is at the clinic, the provider at theclinic delivers the purchased service to the health care consumer. Afterthe service is delivered, the method is directed towards the providerbilling cycle. The provider logs in to the e-commerce platform. Once theprovider is logged into the e-commerce platform, the provider opens thepurchase order associated with the delivered service. The order may bedirectly opened, or the provider may search all orders to retrieve thecorrect order. After opening the purchase order, the provider determinesif the service purchased matches the service delivered. If the servicepurchased matches the service delivered, then the provider may proceedto getting paid for the service.

If the service purchased does not match the service delivered, forexample if additional services were delivered or if the servicepurchased was incorrect, then the provider may modify the order toreflect the changes. If the provider determines an inappropriate servicewas ordered, the provider may make a verbal recommendation to theconsumer for the appropriate service, including the specific cost of theservice. If the consumer verbally agrees (or otherwise approves theadded service), the provider may perform the new service at that time,if it is not substantially different (for example, requiring similartime, equipment, and other resources to the previous, incorrect order).In some examples, the provider may modify the order within 24 hours ofperforming the service. If the new service is substantially differentfrom the previous order, the provider and consumer may discuss a futureappointment.

If the provider determines that an additional service is needed (forexample, imaging, lab work, treatment, etc.) at the time of performingthe purchased service, the provider may make a verbal recommendation tothe consumer for the appropriate service, including the specific cost ofthe service. If the consumer verbally agrees, the provider may performthe new service at that time, if possible and appropriate. In someexamples, the provider may add the additional service to the originalorder on the e-commerce platform within a specified time afterperforming the service. If the additional service is performed at alater time and/or by a separate provider, the consumer may purchase theadditional service through the e-commerce platform.

Providers would like to simplify their administrative processes,particularly the bill review cycle, and eliminate claims complexity.Providers would like to improve their cash flow and reduce patientreceivables. Consumers would also like to eliminate the uncertainty orsurprise of unexpected bills associated with services received.

Thus, systems and methods are provided for making bundles of care looklike a health care service bundle indicator to consumers, procedure anddiagnosis codes to providers, and auto-adjudicated claims to a TPA. Thee-commerce platform eliminates the normal processing overhead associatedwith claims, instead issuing receipt documentation for servicesrendered. This receipt documentation will be issued to consumers whilealso being auto-adjudicated by their insurer to apply against theirhealth plan deductible. Consumers will no longer have to receive orreconcile bills from their provider and their health plan's Explanationof Benefits (EOB) statement.

Providers have the freedom to set their own fees and attract insuredpatients. Money from consumers will be placed into escrow and transfersbetween an employer account and the e-commerce platform paymentprocessor will be configured before services are rendered, ensuringprompt payment to providers for patient services with no financial risk,reducing their patient receivables and improving their cash flow.

Consumers pay at the point of purchase on the e-commerce platform, andfunds are released from the payment processor to a provider once theprovider confirms that purchased services were rendered by submitting aninvoice, or claim. This eliminates the need for providers to file aclaim to a plan administrator and for any surprise bills to consumers.Once this verification takes place, the information will be released tothe plan administrator in the form of a claim, or receipt documentation,with a high probability of auto-adjudication. The plan administratorprocesses the claim and applies it against the consumer's deductible.

FIGS. 7-8 illustrate example methods for a health care billing system.In particular, FIG. 7 shows a high-level flow chart illustrating anexample method 700 for a health care billing system in accordance withthe prior art, while FIG. 8 shows a high-level flow chart illustratingan example method 800 for a health care billing system in accordancewith the current disclosure.

Previous methods, such as method 700 in FIG. 7 , begin with providing ahealth care service to a consumer and billing last. The method 700 istypically carried out by four different entities, including aconsumer/patient 702, a provider 704, a billing entity 706, and a healthcare plan third-party administrator (TPA) 708.

At 710, the consumer 702 goes to a doctor's appointment. At 712, theprovider 704 checks in the patient and verifies eligibility andcoverage. At 714, the provider 704 provides the care to the consumer702. At 715, the consumer leaves the office. At 716, the provider 704updates the electronic medical record (EMR) of the consumer 702 andsends billing information to the billing entity 706. At 718, the billingentity 706 submits a claim to the TPA 708, manually or via aclearinghouse. At 720, the TPA 708 receives the claim. At 722, the TPA708 adjudicates the claim based on coverage and a negotiated rate. At724, the TPA 708 sends a settled claim/remittance to the provider 704.Further, at 726, the TPA 708 creates an explanation of benefits (EOB)for the consumer 702. At 730, the provider 704 receives the settledclaim and creates an invoice for the consumer 702. At 732, the consumer702 receives the bill or invoice from the provider 704 or the billingentity 706. At 734, the consumer 702 receives the EOB from the TPA 708.At 736, if the consumer 702 understands that payment is being requestedvia the invoice or the EOB (“Y”), then the consumer 702 pays theprovider 704 at 738. If the consumer 702 does not understand the invoice(“N”), the member does not pay the provider and sits on the invoice at740. Consequently, the provider 704 sends invoices to the consumer 702until the consumer pays or the debt goes to collection at 742. At 728,the billing entity 706 may determine if the consumer 702 has paid theinvoice, and may continue sending a bill to the consumer 702 (“N”) untilthe consumer pays the invoice (“Y”), at which point the method 700 ends.

In such methods, the provider may not receive payment for a servicerendered until the consumer pays the bill, however the consumer may siton the invoice for an indeterminate amount of time. The consumerreceives an Explanation of Benefits, which may confuse the consumer ashe or she may not understand why some CPT codes are included in thebill.

In contrast, method 800 in FIG. 8 may be carried out by a consumer 802,a provider 804, a TPA 806, and the e-commerce platform 808. The method800 begins at 810, wherein the consumer 802 shops on the e-commerceplatform 808 for health care services. As described above, the consumer802 may select a health care service bundle (represented by a healthcare service bundle indicator) and pay the out-of-pocket cost based onthe consumer's health care plan prior to visiting a provider 804. At812, the consumer 802 visits the provider 804 and receives the purchasedservice. At 814, the consumer 802 may optionally rate the experience viathe e-commerce platform 808.

Meanwhile, at 816 the provider 804 receives the purchased order from thee-commerce platform prior to the consumer 802 visiting the provider 804.After providing the services to the consumer 802, the provider 804checks out the consumer 802 via the e-commerce platform 808.

Meanwhile, after the consumer 802 places an order on the e-commerceplatform at 810, the e-commerce platform receives the order at 820.After the provider 804 checks out the consumer 802 via the e-commerceplatform 808 at 818, the e-commerce platform 808 performs severalactions. At 822, the e-commerce platform remits payment to the providerfor settlement. At 824, the provider 804 accepts the payment via ACH ora merchant account, as non-limiting examples. At 826, the e-commerceplatform 808 remits a claim to the TPA 806 for adjudication. At 828, theTPA 806 adjudicates the claim and posts the claim to the patient file.At 830, the e-commerce platform 808 sends, via a secure email as anon-limiting example or via an interface of the e-commerce platform 808as described above, receipt documentation to the consumer 802. At 832,the consumer 802 receives the receipt documentation from the e-commerceplatform 808. As described herein, the receipt documentation describesthe purchased service, a cost breakdown of the service, technical andnon-technical descriptions of the rendered service, providerinformation, patient information, and health care plan information.

Thus, the method 800 begins with the consumer paying for a health careservice prior to receiving the service. The payment is held in escrow bythe e-commerce platform until the provider delivers the service, and theprovider receives the payment once the provider checks out the consumerthrough the e-commerce platform. The e-commerce platform then sendsreceipt documentation, such as the receipt documentation 672 shown inFIG. 6J, to the consumer. Since the health care consumer ordered andpaid for the bundle of health care services prior to visiting a healthcare provider, there is far less confusion about services rendered andthe cost of each service. In this way, the e-commerce platform increaseshealth care transparency and empowers health care consumers, whilereducing overhead for health care providers.

Consumers might need guidance when purchasing health care services. Asfirst time shoppers in health care, they will want to know which typesof services are often purchased together and what kind of modificationsto their purchase might take place at the provider's office. They willneed clarity that they are purchasing the right services at the righttime. Thus, systems and methods are provided for the generation of apersonalization engine. Similar to the e-commerce shopping sitesconsumers already use for products, consumers will receiverecommendations for services based on their past purchases and thepurchases of other consumers. Consumers will be able to see which healthcare service bundle indicators are commonly purchased together, and whatmodifications and add-ons might take place at the point of service.

FIG. 9 illustrates an example method 900 for personalizing an e-commercehealth care platform for a health care consumer. Method 900 relates to apersonalization engine 920 that analyzes services rendered and tracksconsumer usage. Such a personalization engine 920 is key to consumerengagement and increased “stickiness” over time. The basis of thepersonalization engine is observing consumer behavior. Purchasing habitsof consumers are recorded and categorized by multiple factors includingage, sex, geography, and so on, for example input of other users 904 maybe recorded in a user profile database 914. A personalization database910 may include the user profile database 914 in addition to a userprofile database 912 which records input from the user 902, a providerattributes database 916 which records input from the provider 906, and acurated SKU database 918 which records system parameters 908. Forexample, the curated SKU database 918 may comprise a plurality of healthcare service bundle indicators as discussed herein. At a firstencounter, consumers will receive recommendations based on a curateddatabase of nationally purchased services. Over time, thepersonalization engine 920 will make personalized recommendations 926based on recorded consumer behavior. To that end, the personalizationengine 920 may include a master attribute table 922 and an adjacencyengine 924, which retrieve information from the personalization database910 and process the retrieved information to generate a personalizedrecommendation 926. The personalized recommendation 926 may be input tothe user profile 912.

Several embodiments for an e-commerce marketplace have been describedherein above. In one embodiment, a method comprises, responsive to aquery from a user via a user device, retrieving from a database a listof responses comprising one or more health care providers offering oneor more health care services at a provider-supplied price; filtering thelist of responses based on a geographic location included in the query;providing, for display on the user device, the filtered list ofresponses; receiving a payment from the user for a response selectedfrom the filtered list of responses; automatically sending anotification of the payment to a provider associated with the selectedresponse; and responsive to receiving an order fulfillment notificationfrom the provider, automatically providing the payment to the provider.In some examples, the provider-supplied price may be adjusted by aprovider at any time.

As one example, the method further comprises providing, for display onthe user device, an out-of-pocket cost for each response of the list ofresponses. For example, the payment equals the out-of-pocket cost forthe selected response.

As another example, the method further comprises automatically sending ahealth care claim to a health insurance administrator responsive toreceiving the order fulfillment notification from the provider. Inanother example, the method further comprises automatically sending thehealth care claim to the user in a user-oriented format different than aformat of the health care claim sent to the health insuranceadministrator.

As another example, the one or more services are represented by a healthcare bundle indicator, the health care bundle indicator configured touniquely identify the one or more services, the provider, and a locationof the provider. In one example, the provider-supplied price isassociated with the health care bundle indicator. As an example, thehealth care bundle indicator comprises a sequence of alphanumericalcharacters.

In another embodiment, a computer-readable storage medium including anexecutable program stored thereon, the program configured to cause acomputer processor to: retrieve health care claims data from one or moredatabases; process the health care claims data to identify a combinationof current procedural terminology (CPT) codes provided to a plurality ofpatients in a single health care interaction; assemble the combinationof CPT codes into a bundle of health care services; generate a productcode for a bundle of health care services; receive a price for theproduct code from a health care provider; generate a health care servicebundle indicator for the health care provider based on the product code;and assign the price to the health care service bundle indicator.

In one example, generating the product code is based on one or more of ahealth care category, a health care service group, and a set of healthcare procedures (e.g., the combination of CPT codes) for the bundle ofhealth care services.

As another example, generating the health care service bundle indicatorcomprises concatenating the product code to unit codes associated withthe health care provider. As yet another example, generating the healthcare service bundle indicator further comprises concatenating theconcatenated product code and unit codes associated with the health careprovider with a sequence of alphanumeric characters identifying alocation of the health care provider. In further examples, the unitcodes associated with the health care provider identify an applicableprovider network of the health care provider.

In yet another embodiment, an apparatus facilitating a health caremarketplace comprises a processor and memory storingprocessor-executable instructions that cause the processor to: receive,from a user, a payment for a bundle of health care services provided bya health care provider prior to the user visiting the health careprovider; automatically generate receipt documentation responsive toreceiving an order fulfillment notification from a health care providerindicating that the user received the bundle of health care servicesfrom the health care provider, wherein the receipt documentationincludes one or more current procedural terminology (CPT) codesassociated with the bundle of health care services; send, to the user,the receipt documentation formatted for display to the user andincluding a non-technical description of the one or more CPT codes; andsend, to an insurance administrator for a health insurance plan of theuser, the receipt documentation formatted as a health care claim.

In one example, the receipt documentation includes a list of CPT codesassociated with the bundle of health care services and the paymentreceived.

In another example, the order fulfillment notification includesinformation regarding additional services provided by the health careprovider to the user not included in the receipt documentation sent tothe user, and wherein the receipt documentation sent to the insuranceadministrator includes the information regarding the additionalservices.

In another example, the memory is further storing processor-executableinstructions that cause the processor to, responsive to receiving theinformation regarding the additional services, calculate an additionalpayment from a user based on the information regarding the additionalservices, and request the additional payment from the user. As anexample, the additional payment is calculated based on a healthinsurance benefits plan of the user.

In another example, the payment for the bundle of health care servicescomprises an out-of-pocket cost to the user based on a health insurancebenefits plan of the user.

In another example, the receipt documentation further includes one ormore diagnostic codes, information identifying the user, informationidentifying the health care provider, information regarding the payment,and a cost breakdown indicating an out-of-pocket cost to the user forthe bundle of health care services and an amount covered by the healthinsurance plan of the user.

As used herein, an element or step recited in the singular and proceededwith the word “a” or “an” should be understood as not excluding pluralof said elements or steps, unless such exclusion is explicitly stated.Furthermore, references to “one embodiment” of the present invention arenot intended to be interpreted as excluding the existence of additionalembodiments that also incorporate the recited features. Moreover, unlessexplicitly stated to the contrary, embodiments “comprising,”“including,” or “having” an element or a plurality of elements having aparticular property may include additional such elements not having thatproperty. The terms “including” and “in which” are used as theplain-language equivalents of the respective terms “comprising” and“wherein.” Moreover, the terms “first,” “second,” and “third,” etc. areused merely as labels, and are not intended to impose numericalrequirements or a particular positional order on their objects.

This written description uses examples to disclose the invention,including the best mode, and also to enable a person of ordinary skillin the relevant art to practice the invention, including making andusing any devices or systems and performing any incorporated methods.The patentable scope of the invention is defined by the claims, and mayinclude other examples that occur to those of ordinary skill in the art.Such other examples are intended to be within the scope of the claims ifthey have structural elements that do not differ from the literallanguage of the claims, or if they include equivalent structuralelements with insubstantial differences from the literal languages ofthe claims.

1. An apparatus facilitating a health care marketplace, the apparatuscomprising a processor and memory storing processor-executableinstructions that cause the processor to: receive, from a user, apayment for a bundle of health care services provided by a health careprovider prior to the user visiting the health care provider;automatically generate first receipt documentation and second receiptdocumentation responsive to receiving an order fulfillment notificationfrom the health care provider indicating that the user received thebundle of health care services from the health care provider, whereineach of the first receipt documentation and the second receiptdocumentation includes one or more current procedural terminology (CPT)codes associated with the bundle of health care services; send, to theuser, the first receipt documentation formatted for display to the userand including a non-technical description of the one or more CPT codes;and send, to an insurance administrator for a health insurance plan ofthe user, the second receipt documentation formatted as a health careclaim.
 2. The apparatus of claim 1, wherein each of the first receiptdocumentation and the second receipt documentation further includes oneor more diagnostic codes, information identifying the user, informationidentifying the health care provider, information regarding the payment,and a cost breakdown indicating an out-of-pocket cost to the user forthe bundle of health care services and an amount covered by the healthinsurance plan of the user.
 3. The apparatus of claim 1, wherein theorder fulfillment notification includes information regarding additionalservices provided by the health care provider to the user not includedin the first receipt documentation sent to the user, and wherein thesecond receipt documentation sent to the insurance administratorincludes the information regarding the additional services.
 4. Theapparatus of claim 3, wherein the memory further storesprocessor-executable instructions that cause the processor to:responsive to receiving the order fulfillment notification, calculate anadditional payment from the user based on the information regarding theadditional services; and request the additional payment from the user.5. The apparatus of claim 4, wherein the additional payment iscalculated based on a health insurance benefits plan of the user.
 6. Theapparatus of claim 1, wherein the payment for the bundle of health careservices comprises an out-of-pocket cost to the user based on a healthinsurance benefits plan of the user.
 7. The apparatus of claim 1,wherein the first receipt documentation and the second receiptdocumentation are formatted differently.